Articles: emergency-medical-services.
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Cardiologia (Rome, Italy) · Jul 1992
Comparative Study[The effect of a territorial health emergency service on the delay in the hospitalization of patients with an acute myocardial infarct].
In July 1987 a prehospital emergency medical service (EMS) was activated in Verona (Italy) and a broad educational campaign was introduced. Prehospital care is delivered by emergency physicians and/or qualified nursing staff, who travel by ambulance or helicopter and have radio contact with the hospital alarm centre. During a 1-year period before the activation of the EMS, 476 patients with acute myocardial infarction (AMI) were admitted to the coronary care unit (CCU) of Verona, with a median delay time of 4 hours. ⋯ The time from EMS call to hospital arrival was 25 min and the time which elapsed in the Emergency Department before reaching the CCU was 15 min. In these patients, decision time and Emergency Department time were significantly shorter (p < 0.01) than in patients who did not use the EMS. We conclude that the EMS is effective in reducing delay time in patients with AMI.
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The association between an improved prognosis and early treatment, including surgical intervention, makes air transport for the head-injured patient an important component of care. Patient positioning and the use of hyperventilation have been modes of treatment used for decreasing cerebral edema and ICP for many years. This standard of care should be emphasized during air medical transport as well.
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1. Research shows that many emergency workers are affected physically and emotionally by critical incident stress. 2. Debriefings conducted by trained team members are an effective method to mitigate the impact of critical incident stress. ⋯ Cooperation among community agencies is essential for the development and effective functioning of a critical incident stress debriefing team. 4. Several teams in Illinois have organized to form a Critical Incident Stress Debriefing Network. The Illinois network is part of an international organization composed of critical incident stress debriefing providers.
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Prehospital medications for congestive heart failure should affect hospital outcomes (survival and length of stay). ⋯ Prehospital medications improve survival in congestive heart failure, especially in critical patients. More than one combination of medications seems effective, and early treatment is associated with improved survival. However, these medications appear to increase mortality in patients misdiagnosed in the field. Factors used in paramedica and medical command assessments require further study.
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Emergency thoracotomy is a standard procedure in the management of cardiac arrest in patients sustaining severe trauma. We examined the records of 463 moribund trauma patients treated at our institution from 1980 to 1990 to refine indications for emergency thoracotomy. Patients underwent thoracotomy either in the emergency department (ED) (n = 424) or in the operating room (OR) (n = 39) as a component of continuing resuscitation after hospital arrival. ⋯ Patients with penetrating trauma and in profound shock (BP less than 60 mm Hg) or mild shock (BP 60-90 mm Hg) with subsequent cardiac arrest had survival rates of 64% (27 of 42) and 56% (30 of 54), respectively. None of the patients with absent signs of life, defined as full cardiopulmonary arrest with absent reflexes (n = 215), on initial assessment by paramedics in the field, survived. We conclude that (1) no emergency thoracotomy should be performed if no signs of life are present on the initial prehospital field assessment; (2) emergency thoracotomy is an indicated procedure in most patients sustaining penetrating trauma; (3) blunt traumatic cardiac arrest is a relative contraindication to emergency thoracotomy.